Daniel Reeders

A session offers ‘glimmers of hope’ for innovative and effective HIV prevention and stigma reduction outcomes at multiple levels of the epidemic response (government, health facilities, and community). Being flexible and creative with our interventions and advocacy can secure favorable outcomes for key populations.

Laura Nyblade (USA) describes the methods and findings of an initiative tackling intersecting sexual, gender and HIV stigmas in health facilities in Ghana. Methods include facility training informed by formative evaluation findings. The initiative reduced stigma by about 0.5 points (on a 5-point scale). Frances Ilika (Nigeria) reports on policy enablers of successful advocacy to persuade the government of Lagos State to disburse equity funding for services targeting key populations. Enablers include strategic, targeted, collaborative, integrated multi-sectoral advocacy in alignment with existing government policy. Ria Mae Briñes (Philippines) shares the results of a demand-generation initiative using social media to promote HIV self-testing. Self-testing fills an important gap in the Philippines, where only 63% of people with HIV are aware of their status. Campaigns reached 500,000 people with 20,000 accessing testing, with uptake closely tracking the number of people reached per month. There was a 6% reactivity rate among those who reported their results. Natthakarn Laohacharoensombat (Thailand) reports on testing initiatives that use an ‘online-to-offline’ approach tracking referrals from their online source to offline service uptake and HIV testing outcomes. Online referrals average 46% higher case finding rates, which vary between referral sources (e.g., different hookup apps).

In the session on HIV social science, Catherine Dodds criticized ‘atheoretical’ indices and interventions that conceive and measure stigma as individual negative attitudes, ignoring the social and cultural contexts and power relations that produce it. We cannot hope to achieve transformative change in health care provision without attending to this critique. Outcomes reported by Frances Ilika offer a glimmer of hope in regimes that disregard the needs and dignity of people in key populations. Similarly, data shared by Ria Mae Briñes demonstrate the power and potential of communities doing it for themselves in the absence of effective government responses.